BackgroundDelay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women.MethodsA group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records.ResultsIn all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p < 0.001). Also, a significantly higher risk of more than 6 months delay was found among rural women (P = 0.035) and women who live far away from specialized care center (P = 0.001).ConclusionsDiagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2394-y) contains supplementary material, which is available to authorized users.

Background: Bladder extrophy is a rare congenital anomaly, it is now well reconized that an exstrophy of the bladder is associated with an increased risk of bladder cancer.

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Neuroblastoma is a very uncommon neoplasm in adulthood. It occurs almost exclusively in children younger than ten years (More than 90% of cases). We report the case of a healthy 40-year-old male who complained of a right flank pain in 2010. Clinical examination revealed an enormous abdominal mass involving the adrenal gland as showed at abdominal CT scan. The patient underwent a surgical en-bloc excision of the right adrenal mass, after a laborious dissection of the tumor. Histological and immunohistochemical findings were suggestive of neuroblastoma. Adjuvant treatment was not indicated since the complete gross excision of the tumor was performed, and subsequently, the patient was considered stage 1 disease and because of the unavailability of MYCN status, necessary for achieving risk group stratification and a risk-adapted strategy. The patient remained in good local control, until January 2015 when he accused a locoregional and metastatic relapse consisting of two new para-renal masses and magma of celiac adenomegaly extending into the mediastinum. As the mass was considered unresectable, the therapeutic decision of administrating neoadjuvant chemotherapy, followed by local treatment (surgery and / or radiotherapy) based on tumor response was taken. Given the bad tumor response to systemic treatment, a palliative radiotherapy was instaured. Currently, the patient is two months after the end of radiation with mild clinical improvement. The purpose of presenting this case is not only to report an uncommon malignancy in adulthood but also to raise awareness among clinicians adding this clinical entity as a differential diagnosis when a retroperitoneal mass is identified. We also conducted a literature review to enhance clinicians' acknowledgment about the management of this rare entity in adults.

IntroductionBrain metastasis is a common oncologic problem in adults but is relatively uncommon in children with solid tumors. In fact, approximately 25-35% of all adult cancer patients with solid tumors will develop parenchymal intracranial metastasis whereas only 2.5% to 4.5% of children will do [1][2][3][4][5]. Brain metastasis of clear cell sarcoma of the kidney occurs in less than 5% of cases during the follow-up [6,7]. Because of the relative rarity of this particular entity, information regarding management and prognosis are still missing. Trough the report of

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BackgroundGastric cancer is the second leading cause of cancer related death among men and the fourth among women, and thus represents a significant global health concern [1]. The disease is commonly diagnosed at a locally advanced stage, and surgery remains the main treatment; The overall survival rate of patients who underwent surgery alone is about 45% at 5 years, that has undergone few changes over the last decades [2,3].The curative treatment of gastric cancer requires surgical resection in less than 40% of cases [2,3]. Independent risk factors in the literature are tumor size (>4 cm), age (>70 years), proximal location, diffuse type of Lauren classification, tumor residue, Deep invasion (T3-T4), and the ratio of involved lymph nodes/total number (>20%) [4,5]. Locoregional recurrences on the tumor bed, on the anastomosis or in lymph nodes occur in 40% to 65% of the patients after resection with curative intent [6,7]. The frequency of this relapse makes regional radiotherapy an attractive possibility for adjuvant therapy [8].Various chemotherapy regimens used to prevent relapse and improve the poor survival rates provide small but statistically significant clinical benefit [9,10]. Finally, the intergroup of gastrointestinal cancers was the first to demonstrate in a phase III trial that concomitant radio-chemotherapy after complete gastric resection improves median relapse-free survival (30 vs 19 months, p<0.0001) and overall survival (36 vs 27 months, p<0.01) [11]. Following these results, postoperative radio-chemotherapy according to the Macdonald protocol became the new standard of care [11]. However, much concern remains regarding the toxicity of the regimen. 41% of patients had grade 3 digestive toxicity and 32% grade 4 [11]. The objective of our AbstractBackground: Several studies have shown that surgery alone is not enough in the management of early gastric cancer with locoregional relapse in 40% to 60%. The frequency of relapses makes regional radiotherapy an attractive possibility for adjuvant therapy. The survival benefit of adjuvant chemoradiation over surgery alone was first established by the US Intergroup 0116 study.